Impact of clinical trials on the use of beta blockers after acute myocardial infarction and its relation to other risk indicators for death and 1-year mortality rate

1994 ◽  
Vol 17 (6) ◽  
pp. 311-316 ◽  
Author(s):  
Björn W. Karlson ◽  
Johan Herlitz ◽  
Å. Hjalmarson
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Trials ◽  
Mortality Rate ◽  
Beta Blockers ◽  
Risk Indicators

Intravenous Magnesium Therapy in Acute Myocardial Infarction

1994 ◽  
Vol 28 (2) ◽  
pp. 212-219 ◽  
Author(s):  
Edward M. Hampton ◽  
David D. Whang ◽  
Robert Whang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Trials ◽  
Mortality Rate ◽  
Statistical Significance ◽  
Therapeutic Modality ◽  
Favorable Effect ◽  
Controlled Trials ◽  
Baseline Serum ◽  
Intravenous Magnesium

OBJECTIVE: To review the methods and summarize the findings of clinical trials evaluating the use of intravenous magnesium (Mg2+) in acute myocardial infarction (AMI); to discuss serum Mg2+ in AMI and the potential mechanisms by which intravenous Mg2+ may be effective. Tables are used extensively to provide detailed information about the various trials. DATA SOURCES: A MEDLINE search was used to identify pertinent literature. Additional references were obtained from the articles retrieved from that search. STUDY SELECTION: Studies randomized and/or placebo-controlled were selected for review. Additional relevant citations were used in the introductory material and discussion. DATA EXTRACTION: There were surprisingly few large, placebo-controlled trials. All clinical trials available at the time of publication were reviewed. Only eight trials enrolled sufficient numbers of patients and/or were of adequate design to make meaningful interpretations. The description of the methods and results of these articles are the basis of this review. Although additional controlled studies with more subjects are needed, the results to date form a foundation from which to make inferences regarding the utility of this therapeutic modality. DATA SYNTHESIS: Intravenous Mg2+ has been demonstrated, albeit inconclusively, to reduce immediate and long-term morbidity and mortality when given in the immediate postinfarction period. Six of the eight controlled trials discussed report a decrease in the overall incidence of arrhythmia or in the frequency of arrhythmia requiring treatment. Four of the eight reported statistical significance. Five of the six trials evaluating mortality reported a decrease in the mortality rate from intravenous Mg2+ administered post-MI. Four of the five reported statistical significance. The favorable effect of intravenous Mg2+ on the mortality rate appears to occur in the first 30 days post-MI and is maintained through at least one year. The effects appear to be independent of concurrent therapy and do not appeart to relate to baseline serum Mg2+ concentrations. Intravenous Mg2+ appears to be safe and well tolerated. Flushing, hypotension, and atrioventricular (AV) node conduction abnormalities occur on occasion and seem related to the rate of administration. The exact dosage in this setting remains to be determined. CONCLUSIONS: Additional, well-designed, multicenter, controlled trials evaluating intravenous Mg2+ in AMI are needed. The pending Fourth International Study of Infarct Survival, with an anticipated 400 000 subjects, should clarify a number of unresolved issues regarding this therapy. Based on the information available to date, however, intravenous Mg2+ as a significant therapeutic modality for AMI shows promise. Pending further investigation, however, it should be avoided in patients with significant sinoatrial or AV conduction disturbances.

Abstract 3522: Transfer Patients With Acute Myocardial Infarction Do Not Impact Hospital Quality Measurements, Despite Being Sicker Than Directly Admitted Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Creighton Don ◽  
Douglas Stewart ◽  
Susan Heckbert ◽  
Charles Maynard ◽  
Richard Goss
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blockers ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Hospital Quality ◽  
Lipid Lowering ◽  
Hospital Death ◽  
Hospital Level ◽  
Risk Of Death

BACKGROUND Studies of hospital quality and national performance measures for acute myocardial infarction (AMI) frequently exclude transfer patients. Little is known about the clinical characteristics and outcomes of patients with AMI transferred for revascularization. HYPOTHESIS Transfer patients have greater clinical comorbidity and worse hospital survival than non-transfer patients, and negatively impact hospital quality measures. METHODS A retrospective-cohort study was performed using all patients with ST-elevation myocardial infarction who underwent coronary intervention or coronary artery bypass grafting (CABG) in Washington State from 2002 – 2005. Data on clinical and procedural characteristics, medications, and complications were obtained from the Clinical Outcomes Assessment Program. Hospitals were compared by rates of death and discharge with aspirin, beta-blockers, lipid lowering agents, and ACE inhibitors. Logistic regression was used for adjusted analysis. RESULTS Of patients undergoing revascularization for AMI, 7080 were directly admitted and 2910 were transferred. Diabetes (23.4 v. 19.7%, p<0.01), hypertension (61.3 v. 55.7%, p<0.01), and thrombolysis (32.3 v. 3.4%, p <0.01) were greater among transfers. Transfers presented with a higher rate of left main and three-vessel disease, intra-aortic balloon pump use (6.4 v. 3.6%, p<0.01) and underwent CABG more frequently (15.4 v. 5.5%, p <0.01). Transfer patients had a lower risk of death (3.9 v. 4.9%, p=0.03), but no difference in discharge medication prescription. Adjusting for major risk factors, procedure, and hospital type, transfers had a similar risk for in-hospital death compared to non-transfers (OR 0.9, CI 0.5 – 1.6). Hospitals with a high percentage of transfers treated higher-risk patients, but had similar outcomes to those with few transfers. Excluding transfers from the hospital-level analysis did not appreciably change these results. CONCLUSION Transfers were higher-risk, but had similar in-hospital mortality and were equally likely to receive appropriate medication at discharge compared to directly admitted patients. Inclusion of transfers did not affect hospital-level inpatient mortality or measurements of adherence to quality guidelines.

Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YeeKyoung KO ◽  
Seungjae JOO ◽  
Jong Wook Beom ◽  
Jae-Geun Lee ◽  
Joon-Hyouk CHOI ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

Impact of resuscitation and thrombolysis on mortality rate from acute myocardial infarction

1995 ◽  
Vol 49 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Roger Trent ◽  
Jacqueline Adams ◽  
Kevin Jennings ◽  
John Rawles
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mortality Rate
Sign in / Sign up

Export Citation Format

Share Document